Nationwide partial knee replacement uptake is influenced by volume and supplier--A Dutch arthroplasty register study.

BACKGROUND: Despite the established advantages of partial knee replacements (PKR), their usage remains limited. We investigated the effect of hospital knee arthroplasty (KA) volume and the availability of a frequently used PKR by the total KA supplier on the use of PKRs in a hospital. METHODS: A total of 190,204 total knee replacements (TKR) and 18,134 PKRs were identified in the Dutch Arthroplasty Register (LROI) from 2007 to 2016. For each hospital we determined the annual absolute KA volume (TKR+PKR) into quartiles (<103, 103-197, 197-292, >292 knee replacements/year), and determined whether the TKR supplier provided a frequently used PKR. Hospitals were divided in routine PKR users (≥13 PKRs/year) or occasional/non PKR users (<13 PKRs/year). Based on these parameters, the effect of total KA volume and supplier on PKR usage was investigated, using chi-square tests. Logistic regression analysis was performed to evaluate the influence of the combination of these factors. RESULTS: In the lowest volume group, around 15% of the hospitals used PKRs, compared to 75% in the highest volume group. Having a TKR supplier that also provides a frequently used PKR resulted in a higher likelihood of performing PKR, especially in low volume hospitals. CONCLUSIONS: Hospitals' total KA volume and the availability of a frequently used PKR appear to influence the use of PKR.

Assessing the Efficacy of an Educational Smartphone or Tablet App With Subdivided and Interactive Content to Increase Patients' Medical Knowledge: Randomized Controlled Trial.

BACKGROUND: Modern health care focuses on shared decision making (SDM) because of its positive effects on patient satisfaction, therapy compliance, and outcomes. Patients' knowledge about their illness and available treatment options, gained through medical education, is one of the key drivers for SDM. Current patient education relies heavily on medical consultation and is known to be ineffective. OBJECTIVE: This study aimed to determine whether providing patients with information in a subdivided, categorized, and interactive manner via an educational app for smartphone or tablet might increase the knowledge of their illness. METHODS: A surgeon-blinded randomized controlled trial was conducted with 213 patients who were referred to 1 of the 6 Dutch hospitals by their general practitioner owing to knee complaints that were indicative of knee osteoarthritis. An interactive app that, in addition to standard care, actively sends informative and pertinent content to patients about their illness on a daily basis by means of push notifications in the week before their consultation. The primary outcome was the level of perceived and actual knowledge that patients had about their knee complaints and the relevant treatment options after the intervention. RESULTS: In total, 122 patients were enrolled in the control group and 91 in the intervention group. After the intervention, the level of actual knowledge (measured on a 0-36 scale) was 52% higher in the app group (26.4 vs 17.4, P<.001). Moreover, within the app group, the level of perceived knowledge (measured on a 0-25 scale) increased by 22% during the week within the app group (from 13.5 to 16.5, P<.001), compared with no gain in the control group. CONCLUSIONS: Actively offering patients information in a subdivided (per day), categorized (per theme), and interactive (video and quiz questions) manner significantly increases the level of perceived knowledge and demonstrates a higher level of actual knowledge, compared with standard care educational practices. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number ISRCTN98629372; http://www.isrctn.com/ISRCTN98629372 (Archived by WebCite at http://www.webcitation.org/73F5trZbb).

Considerable variety in usual care rehabilitation after knee arthroplasty : a survey amongst physiotherapists.

Knee arthroplasty (KA) is increasingly performed, but rehabilitation and the possibility of returning to sports after KA are understudied areas. A web-based survey amongst physiotherapists was conducted to obtain insight in current rehabilitation methods and their return to sports advice after KA. 82 physiotherapists (62%) completed the survey. Broad agreement existed concerning important goals of rehabilitation, including the improvement of ROM, muscle strength, coordination and gait pattern. However, physiotherapists use a wide variety of treatment strategies to achieve these goals. Return to low-impact sports is mostly recommended, while return to intermediate- and high-impact sports is either advised against or considered impossible. The development of new evidence-based guidelines on physiotherapy after KA could lead to a more uniform approach in the rehabilitation for KA patients. Furthermore, investigating effects of individualization in the rehabilitation may prove valuable in optimising both patient outcomes and cost-effectiveness of this worldwide increasingly performed intervention.